Ifr Maintenance Requirements
Christian Swindler
House maintenance requirements typically range between 30% and 50%. While stocks are the security most commonly purchased in a margin account, many other securities such as mutual funds, Treasuries, corporate bonds, and options may be purchased "on margin" subject to varying purchase and maintenance requirements.
A maintenance requirement of 30% means an investor borrowing on margin must have at least 30% of the total market value of the securities in their margin account at all times. So, if the securities that you borrowed money to buy are valued at $20,000, the maintenance requirement would be $6,000.
The same maintenance requirements are not uniformly applied to everyone and everything. Some securities can carry higher maintenance requirements because they are deemed riskier. That's usually the case with more volatile or less liquid investments.
The 21st Century Cures Act (Section 4002) requires the Secretary of Health and Human Services (HHS) to establish Conditions and Maintenance of Certification requirements for the ONC Health IT Certification Program. ONC has finalized the Conditions and Maintenance of Certification requirements to express initial requirements and ongoing requirements for health IT developers and their Certified Health IT Module(s). There are seven Conditions of Certification with accompanying Maintenance of Certification Requirements. ONC has not yet established an EHR Reporting Program for the seventh Conditions and Maintenance of Certification requirement; the EHR reporting criteria submission. Once ONC establishes such program, we will undertake rulemaking to propose and implement the associated Condition and Maintenance of Certification requirements for health IT developers.
The Conditions and Maintenance of Certification requirements, except for the Information Blocking and Assurances Conditions and Maintenance of Certification requirements, apply only to actions and behaviors of health IT developers related to their certified health IT as well as to the certified health IT itself. The Information Blocking and Assurances Conditions and Maintenance of Certification require that a health IT developer is responsible to ensure that all of its health IT and related actions and behaviors do not constitute information blocking or inhibit the appropriate access, exchange, and use of electronic health information (EHI).
The Conditions and Maintenance of Certification requirements are defined in Subpart D of the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program Final Rule (ONC Cures Act Final Rule). Furthermore, compliance dates have been updated per the Interim Final Rule (IFR), Information Blocking and the ONC Health IT Certification Program: Extension of Compliance Dates and Timeframes in Response to the COVID-19 Public Health Emergency.
A health IT developer must provide responses to the Insights Condition of Certification annually for any Health IT Module that has or has had an active certification at any time under the Certification Program during the prior six months.
The FFCRA provides a 6.2 percentage point increase in the federal share of Medicaid spending with requirements to maintain eligibility. The increase does not apply to Affordable Care Act (ACA) Medicaid expansion adults, for whom states continue to receive a 90% federal matching rate. The Federal Medical Assistance Percentage (FMAP) increase was retroactive to January 1, 2020, and is in place until the end of the quarter in which the PHE ends.
The MOE requirements also provide continuous coverage for current enrollees. Specifically, states must provide continuous eligibility through the end of the month in which the PHE ends for those enrolled as of March 18, 2020, or at any time thereafter during the PHE period. In guidance to states through FAQs, CMS originally interpreted the MOE to allow states to act on changes in circumstances to move individuals into eligibility categories that provide additional benefits but prohibited states from moving individuals into eligibility categories with fewer benefits.5 The original guidance further prohibited states from increasing cost-sharing or restricting benefits.
If ineligible for another full-benefit group, remain in low-income child group.Young adult turns 21Continue providing EPSDTStop providing EPSDTACA expansion adult turns 65Remain enrolled in expansion group. Add Medicare Savings Program (MSP) group if eligible for Medicare cost-sharing assistanceTerminate expansion group enrollment and enroll in another full-benefit Medicaid group if eligible. Also enroll in MSP group if eligible.
If ineligible for another full-benefit Medicaid group or MSP, continue expansion group enrollment (even if receiving Medicare).Woman reaches end of 60 day post-partum periodRemain enrolled in pregnant woman groupIf eligible for another full benefit group, such as ACA expansion, and benefit package for new group is the same or more generous than pregnant woman benefit package, move to new group.
The IFR reverses earlier guidance by allowing states to make benefit and cost-sharing changes and continue to receive the FMAP bump. States may eliminate optional benefits as well as change the scope of benefits, such as service authorization criteria. States may also establish or increase cost-sharing and increase the patient liability amount for those receiving long-term services and supports (LTSS) under post-eligibility treatment of income rules.
By drawing down the enhanced federal funds, states are indicating to CMS that they will comply with the MOE conditions.13 CMS will not require a separate demonstration of compliance from states but will allow states to passively attest by drawing down the funds. If CMS later determines that the state does not satisfy all of the conditions, the state must return the enhanced funds.14 CMS has stated it is not aware of any states not taking enhanced federal funds.15
Beyond the MOE requirements, states can streamline eligibility and enrollment processes to help connect people to coverage more quickly, and many are doing so through emergency authorities. Nearly all (47) states are making changes to streamline eligibility and/or enrollment through State Plan Amendments (SPAs) or other administrative authority beyond what is required to access the enhanced federal funding. States can make changes through a regular SPA or Disaster-Relief SPA as well as other authorities. States have flexibility to expand eligibility or modify eligibility rules, eliminate or waive premiums, and streamline application and enrollment processes. Specific actions states are taking include expanding Medicaid coverage to optional groups, allowing increased used of self-attestation to expedite enrollment, eliminating premiums, as well as expanded use of presumptive eligibility.
After the end of the PHE, states must resume renewals and redeterminations in accordance with current Medicaid rules. These rules differ somewhat for enrollees whose eligibility is based on modified adjusted gross income (MAGI groups, including pregnant women, low-income parents, and low-income children) and non-MAGI enrollees (groups where eligibility is based on old age or disability).
CMS issued an informational bulletin on December 4, 2020, that reiterates these current renewal and redetermination rules for states but does not address processes at the end of the PHE. CMS is encouraging states to conduct renewals and redeterminations to the extent possible during the PHE and plans to issue more specific guidance later about the end of the PHE.21 This guidance could include more specific instructions to states about policies and processes for addressing redetermination and renewal backlogs that may have accumulated during the PHE, when data matches for income must be conducted, when to determine current income (for example, when states must conduct another updated eligibility determination to check for subsequent changes in circumstances for individuals who maintained eligibility only due to the MOE), and what notices will be required when the PHE ends. Prior to the PHE, CMS had encouraged states to enhance verification processes and conduct periodic data checks, which may have contributed to enrollment declines.
How will states implement requirements and options in the new IFR? It is unclear how many individuals will be transitioned to alternative eligibility pathways within the same coverage tier, how enrollees will be notified of such a change, and how administratively challenging such transitions will be for states. The recent CMS bulletin also affirms current rules that if an individual is determined eligible following a change in circumstances, states can start a new 12-month renewal period if all other eligibility criteria can be verified. While few states have used this option, more states may use this option to help stagger renewals following the end of the PHE. In addition, it will be important to watch if states restrict benefits or increase cost-sharing, particularly as Governors develop budgets for the upcoming fiscal year and states continue to face economic pressures and reduced revenues.
Will the PHE be extended and for how long? The current PHE declaration expires on January 20, 2021, and it is expected it will be extended either by the current Administration or under by the Biden Administration for at least another 90 days. If the PHE is not extended, continuous coverage requirements will end on January 31, 2021, and the enhanced FMAP and other MOE requirements will expire on March 31, 2021. State eligibility and enrollment flexibilities through Disaster-Relief SPAs during the PHE will also expire. Providing more transparency or clarity on how long the PHE is likely to remain in place will be helpful to states as they prepare for when continuous coverage and other MOE requirements end.
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